Premenstrual Dysphoric Disorder – when paracetamol just isn’t enough

A disorder that thousands of females suffer with, but have no idea that's what they could be experiencing.

Moodiness, food cravings, tiredness, headaches. I’m sure the majority of females recognise these symptoms as they are prominent in the weeks before coming on to your period. This is called premenstrual syndrome or PMS, as it is more commonly known, and is pretty much accepted in society as something to just get on with. PMS is experienced by 90% of menstruating people with most only experiencing mild symptoms. The majority of females are able to carry on with their day with the help of a paracetamol or two, and a sharing bag of giant chocolate buttons (personal preference). But what if these symptoms are so severe that they impair daily functioning like going to work or school? This may be a sign of premenstrual dysphoric disorder or PMDD for short, and many females are unaware of this condition.

What is premenstrual dysphoric disorder?

PMDD is a diagnosable health problem, similar to PMS but with much more severe symptoms and a significant impact on daily functioning. The symptoms occur a week or two before the period starts and generally subside a few days after the start of the period.

Symptoms of premenstrual dysphoric disorder

• Lasting irritability or anger that may affect other people
• Feelings of sadness or despair, or even thoughts of suicide
• Feelings of tension or anxiety
• Panic attacks
• Mood swings or crying often
• Lack of interest in daily activities and relationships
• Trouble thinking or focusing
• Tiredness or low energy
• Food cravings or binge eating
• Trouble sleeping
• Feeling out of control
• Physical symptoms such as cramps, bloating, breast tenderness, headaches, and
joint or muscle pain
To be diagnosed with PMDD you must have 5+ symptoms, including one mood-related symptom e.g. mood swings, feelings of sadness or anxiety.

Who gets premenstrual dysphoric disorder?

PMDD affects between 3-8% of women at childbearing age (after puberty and before the menopause), with many females having a diagnosis of depression or anxiety too. This figure is highly likely to be underestimated due to the lack of awareness of the condition.

Causes of premenstrual dysphoric disorder?

Unfortunately, the cause of PMDD is currently unknown. However, as the vast majority of people have normal levels of sex hormones, it is thought to be caused by a negative response to the fluctuation of these hormones during the menstrual cycle.

What should I do if I think I have premenstrual dysphoric disorder?

If you think you have PMDD, you should visit your GP to discuss your concerns. It’s also recommended to keep a symptom diary over a few months, alongside tracking your menstrual cycle and bring this with you to the appointment. This will help the doctor diagnose PMDD as the symptoms have to be in line with the timeline of the menstrual cycle. There are a few useful and free apps you can download to track your symptoms easily:
Me v PMDD
Clue
If you prefer to use pen and paper, there is also a pre-prepared sheet you can print off called the Daily Record of Severity of Problems which can be found via the link. You may also want to use this Self-Screen Tool which was produced by the International Association of Premenstrual Disorders if you’re unsure of your symptoms, but it is always recommended to seek help from a professional if you have concerns.

Treatments for premenstrual dysphoric-disorder
SSRI antidepressants

These are serotonin reuptake inhibitors which alter the serotonin levels in the brain and are commonly used to treat depression. These can be taken either continuously or just in the weeks before your period.mo

Contraceptive pills

This may sound controversial, as contraceptive pills are known to induce mood swings and in some cases depression, but for PMDD some forms of contraception may actually improve symptoms. This is based on the idea that by blocking a normal ovulatory cycle (with birth control), hormone fluctuation does not occur, thus neither do the PMDD symptoms associated with it.
‘Yaz’ is a combined contraceptive pill that is FDA-approved to specifically treat PMS and PMDD and there are multiple research studies confirming its effectiveness.
'Yaz' pill and packet

Pain relief

A more classical approach used to treat common PMS symptoms can relieve the physical symptoms of PMDD such as cramps and headaches.
However, there is no one-size-fits-all treatment for PMDD and every individual is different. Similar to contraception, it’s a case of finding what works best for you.

Current barriers

One of the main barriers for understanding and treatment of both PMS and PMDD is that symptoms are largely accepted as a ‘normal’ experience of the menstrual cycle. This has led to lack of research in the field. For example, despite PMS affecting 90% of females, it is chronically understudied. This is shown in relation to erectile dysfunction which affects 52% of males, yet has five times the amount of research and hundreds of treatments available. This lack of research has huge implications for both the understanding and treatment of PMDD, as currently there are no tests e.g. blood or saliva tests to confirm PMDD, and diagnosis is largely up to your doctor’s discretion. This has issues within itself as women report struggling to get a diagnosis due to their symptom severity being doubted or doctors not even knowing the disorder.
It is time to turn our attention to the 90% of females who experience discomfort in the weeks leading up to their period and try to get a clearer picture as to why this is much worse for some than others.
If you would like to know more or need support, please follow the links below:
International Association of Premenstrual Disorders
Mind Website 
UK PMDD Support Group
Be sure to join the conversation over at The Lowdown where you can talk about your experiences with contraception.